This entry is our analysis of a review or synthesis of research findings added to the Effectiveness Bank. The original review was not published by Findings; click Title to order a copy. Free reprints may be available from the authors – click prepared e-mail. Links to other documents. Hover over for notes. Click to highlight passage referred to. Unfold extra text The Summary conveys the findings and views expressed in the review. Below is a commentary from Drug and Alcohol Findings.

Constantino M.J., Arnkoff D.B., Glass C.R. et al.Journal of Clinical Psychology: 2011, 67(2), p. 184–192.Unable to obtain a copy by clicking title? Try asking the author for a reprint by adapting this prepared e-mail or by writing to Dr Constantino at mconstantino@psych.umass.edu.

Meta-analytic review commissioned by a US task force concludes that patients who enter psychotherapy with positive expectations about outcomes tend to actually have better outcomes, suggesting that therapists should regularly assess expectations and take steps to enhance them if appropriate.

[Though not specific to patients with drug and alcohol problems, studies in the analyses described included such patients, and the principles are likely to be applicable to these disorders among others, not least because substance use problems generally form part of a complex of broader psychosocial problems.]

There is some evidence that expectations affect outcomes via an improved collaborative working relationship with the therapist, and perhaps too by promoting greater patient adherence to treatment. What determines whether patients have positive expectations remains unclear, but it may be related to the severity of their symptoms or their general level of hope versus hopelessness.

Finally, we discuss limitations of the research base and offer practice suggestions based on our findings. Among these are the suggestion that therapists explicitly assess patients' prognostic expectations at the beginning of treatment. Depending on what is revealed (verbally or through a brief measure), therapists can verify and validate their patients' beliefs, and consider behaving in ways which match the patient's level of optimism. These methods may include carefully nuanced comments intended to enhance optimism, such as reminding the patient of how far they have already come or of research indicating positive outcomes, or cautions to check unrealistically high expectations without damaging self-esteem. Throughout therapy, therapists should consider regularly checking patients' outcome expectations and responding accordingly.